How COVID-19 has affected gastroenterology practices

Though the hallmark symptoms of COVID-19—cough, fever, and shortness of breath—have categorized the disease as a respiratory illness, many patients also suffer various digestive symptoms. Such findings on COVID-19’s effects on the gastrointestinal tract have not only caused gastroenterologists to get involved in treatment, but also to change the very way in which they operate.

A new Stanford Medicine study collected data on 116 patients who tested positive for COVID-19 at Stanford Health Care from March 4 to 24, 2020. In addition to upper respiratory symptoms, gastrointestinal symptoms such as nausea, loss of appetite, and diarrhea were reported by 31.9% of patients.

Similar results were found in a study conducted in Wuhan, China, where the virus originated. An analysis of 204 COVID-19 patients found that more than half reported digestive symptoms. “Clinicians should recognize that digestive symptoms, such as diarrhea, are commonly among the presenting features of COVID-19,” the study’s authors wrote, “and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms.”

In March 2020, a joint advisory issued by American gastroenterological associations acknowledged the potential for coronavirus transmission through droplets and fecal shedding. To avoid the risk of infection, the advisory recommended that patients reschedule elective non-urgent endoscopic procedures.

COVID-19’s effects on gastroenterology practices

So, what has the pandemic meant for gastroenterologists across the nation? For starters, gastroenterology and endoscopy practices have taken unprecedented action to protect their staff and patients. But they’ve also adopted technology and delayed care that would otherwise have been performed, showing just how much this area of medicine changed in a short time.

Rajeev Jain, MD, a gastroenterologist in Dallas, TX, said in an interview with The New York Times that he had canceled all appointments that weren’t immediately necessary. He said that he now spends a considerable amount of time talking to patients who are concerned about whether they should stop taking their immunosuppressive medications to reduce their risk of infection. In most cases, Dr. Jain has recommended patients continue their normal treatment.

Gastroenterologists across the country are facing similar questions and challenges. A new online survey published in Gastroenterology shines a light on such changes by calculating the impact of COVID-19 on practices like Dr. Jain’s. The survey’s results provide a comprehensive overview of the changes gastroenterologists have implemented in response to the pandemic—and the challenges that lie ahead.

The survey, which was sent to gastroenterologists across North America, garnered 73 responses received between March and April 2020. It asked respondents about issues like virus screening, new personal protective equipment (PPE) procedures, and changes in clinical, consultative, and training practices.

According to the findings, most practices increased their safety procedures substantially. The vast majority (86%) were screening patients for COVID-19 upon arrival at the office, and the same percentage of practices reported expanded use of PPE.

But the use of surgical masks vs N95 respirators varied. “Though early evidence suggests that standard surgical masks may be sufficient in non-high-risk scenarios, it remains critical to elucidate whether endoscopy produces respiratory aerosols fine enough to penetrate standard masks,” the authors wrote of this disparity.

Operating procedure between the centers also differed. More than half of respondent practices (55%) said their clinics were partly closed, and 21% reported being fully closed. Most practices were operating at less than 10% of their normal endoscopy volume, and almost all (96%) of the institutions had implemented telemedicine visits. The use of virtual doctor visits has become increasingly attractive for patients looking for faster diagnoses, more efficient care, and a less stressful experience.

An MDLinx survey of physicians of all kinds (most in private practice) revealed similar findings. Two-thirds of physicians surveyed reported that their patient visits dropped by 50% or more in their practices. This includes about one-third of physicians who reported that they lost more than 75% of all their in-person patient visits. Nearly 14% of physicians surveyed said they stopped seeing patients altogether or have closed their practices. 

According to the Gastroenterology survey, most gastroenterology practices weren’t hesitant to delay certain procedures. In fact, 97% of centers said they had postponed screening colonoscopies. While respondents expect to face a surplus of procedures when normal operations resume, almost two-thirds said they had no plan to address that backlog. The centers that mapped out plans for delayed procedures favored weekend and after-hours treatments.

When it came to training procedures, 75% of responding centers reported that fellows continued to conduct face-to-face inpatient consultations. A significant number of programs (41%) had limited fellow involvement in endoscopy to select cases only, and 49% had eliminated their involvement completely.  

How can gastroenterology move forward?

When the COVID-19 pandemic gripped the world in early 2020, the CDC recommended the interim cancellation of elective surgical procedures. This has caused financial and operational upheaval throughout healthcare, with major declines in revenue being reported by health systems across the country. According to the American Hospital Association, hospitals are losing an estimated $50 billion a month, and the aggregate 4-month loss will total $200 billion by the end of June.

It’s no surprise, then, that the Gastroenterology survey provides a snapshot of how specialty medicine has responded to the COVID-19 pandemic yet offers little insight into medicine’s uncertain future. Researchers continue to uncover symptomatic correlations, such as the GI tract’s role in identifying and diagnosing the virus. In short, just as the medical community has learned of the importance of gastroenterologists in fighting COVID-19, these same physicians are struggling to keep their practices online.